Update on Prevention and Surgical Management of Negative Dysphotopsia
Narrative Responses:
Purpose
Reserach suggests that negative dysphotopsia (ND) occurs with "in the bag" IOLs and may be relieved if the optic is anterior to the capsulorrhexis. The investigation reviews surgical experience in managing or preventing ND, and a novel anti-dysphotpic IOL is presented.
Methods
1 - Case series: To date the authors have performed surgery for 33 eyes with respect to ND. 25 eyes had symptomatic ND and had either a piggy back IOL, IOL exchange or IOL repositioning (secondary reverse optic capture). 8 patients had primary reverse optic capture in the second eye following symptomatic ND after cataract surgery in the first eye. 2 - Prospective investigation of a novel anti-dysphtopic IOL. The IOL has a peripheral groove, allowing the anterior capsulotomy to be captured and the anterior edge of the optic to project in front of the capsulotomy.
Results
ND Symptoms were improved, eliminated, or prevented surgically in 30 of 33 eyes: 8/10 eyes were aided with piggy back IOLs, 2/3 with IOL exchange, 12/12 with secondary reverse optic capture, and 8/8 with primary reverse optic capture. 5/5 patients implanted with the novel IOL experienced no ND or any untoward effects of surgery.
Conclusion
While ND remains somewhat enigmatic at this time, patients with chronic symptoms may be aided by surgery and new IOL designs may prove preventative.